Sodium Intake as a Cardiovascular Risk Factor: A Narrative Review

While sodium is essential for human homeostasis, current salt consumption far exceeds physiological needs. Strong evidence suggests a direct causal relationship between sodium intake and blood pressure (BP) and a modest reduction in salt consumption is associated with a meaningful reduction in BP in hypertensive as well as normotensive individuals. Moreover, while long-term randomized controlled trials are still lacking, it is reasonable to assume a direct relationship between sodium intake and cardiovascular outcomes. However, a consensus has yet to be reached on the effectiveness, safety and feasibility of sodium intake reduction on an individual level. Beyond indirect BP-mediated effects, detrimental consequences of high sodium intake are manifold and pathways involving vascular damage, oxidative stress, hormonal alterations, the immune system and the gut microbiome have been described. Globally, while individual response to salt intake is variable, sodium should be perceived as a cardiovascular risk factor when consumed in excess. Reduction of sodium intake on a population level thus presents a potential strategy to reduce the burden of cardiovascular disease worldwide. In this review, we provide an update on the consequences of salt intake on human health, focusing on BP and cardiovascular outcomes as well as underlying pathophysiological hypotheses.

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Urine Spot Samples Can Be Used to Estimate 24-Hour Urinary Sodium Excretion in Children

Journal of Nutrition ◽

10.1093/jn/nxy211 ◽

2018 ◽

Vol 148 (12) ◽

pp. 1946-1953 ◽

Cited By ~ 6

Author(s):

Magali Rios-Leyvraz ◽

Pascal Bovet ◽

René Tabin ◽

Bernard Genin ◽

Michel Russo ◽

...

Keyword(s):

Sodium Excretion ◽

Salt Intake ◽

Sodium Intake ◽

Population Level ◽

Urinary Sodium Excretion ◽

Cross Sectional Study ◽

Urinary Sodium ◽

Cross Sectional ◽

High Sodium ◽

Individual Level

ABSTRACT Background The gold standard to assess salt intake is 24-h urine collections. Use of a urine spot sample can be a simpler alternative, especially when the goal is to assess sodium intake at the population level. Several equations to estimate 24-h urinary sodium excretion from urine spot samples have been tested in adults, but not in children. Objective The objective of this study was to assess the ability of several equations and urine spot samples to estimate 24-h urinary sodium excretion in children. Methods A cross-sectional study of children between 6 and 16 y of age was conducted. Each child collected one 24-h urine sample and 3 timed urine spot samples, i.e., evening (last void before going to bed), overnight (first void in the morning), and morning (second void in the morning). Eight equations (i.e., Kawasaki, Tanaka, Remer, Mage, Brown with and without potassium, Toft, and Meng) were used to estimate 24-h urinary sodium excretion. The estimates from the different spot samples and equations were compared with the measured excretion through the use of several statistics. Results Among the 101 children recruited, 86 had a complete 24-h urine collection and were included in the analysis (mean age: 10.5 y). The mean measured 24-h urinary sodium excretion was 2.5 g (range: 0.8–6.4 g). The different spot samples and equations provided highly heterogeneous estimates of the 24-h urinary sodium excretion. The overnight spot samples with the Tanaka and Brown equations provided the most accurate estimates (mean bias: −0.20 to −0.12 g; correlation: 0.48–0.53; precision: 69.7–76.5%; sensitivity: 76.9–81.6%; specificity: 66.7%; and misclassification: 23.0–27.7%). The other equations, irrespective of the timing of the spot, provided less accurate estimates. Conclusions Urine spot samples, with selected equations, might provide accurate estimates of the 24-h sodium excretion in children at a population level. At an individual level, they could be used to identify children with high sodium excretion. This study was registered at clinicaltrials.gov as NCT02900261.

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Is too much salt harmful? Yes

Pediatric Nephrology ◽

10.1007/s00467-019-04387-4 ◽

2019 ◽

Vol 35 (9) ◽

pp. 1777-1785 ◽

Cited By ~ 1

Author(s):

Róbert Agócs ◽

Dániel Sugár ◽

Attila J. Szabó

Keyword(s):

Blood Pressure ◽

Salt Intake ◽

Sodium Intake ◽

Blood Pressure Reduction ◽

Great Part ◽

Risk Groups ◽

Vulnerable Groups ◽

High Sodium ◽

Salt Consumption ◽

Low Sodium Diet

AbstractThe contribution of high sodium intake to hypertension and to the severity of immune-mediated diseases is still being heatedly debated in medical literature and in the lay media. This review aims to demonstrate two conflicting views on the topic, with the first part citing the detrimental effects of excessive salt consumption. Sodium plays a central role in volume and blood pressure homeostasis, and the positive correlation between sodium intake and blood pressure has been extensively researched. Despite the fact that the average of global daily salt consumption exceeds recommendations of international associations, health damage from excessive salt intake is still controversial. Individual differences in salt sensitivity are in great part attributed to this contradiction. Patients suffering from certain diseases as well as other vulnerable groups—either minors or individuals of full age—exhibit more pronounced blood pressure reduction when consuming a low-sodium diet. Furthermore, findings from the last two decades give insight into the concept of extrarenal sodium storage; however, the long-term consequences of this phenomenon are lesser known. Evidence of the relationship between sodium and autoimmune diseases are cited in the review, too. Nevertheless, further clinical trials are needed to clarify their interplay. In conclusion, for salt-sensitive risk groups in the population, even stricter limits of sodium consumption should be set than for young, healthy individuals. Therefore, the question raised in the title should be rephrased as follows: “how much salt is harmful” and “for whom is elevated salt intake harmful?”

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Urinary sodium excretion in a young to middle-aged adults urban population: a pilot study in Ecuador

Revista de Salud Pública ◽

10.15446/rsap.v20n5.73019 ◽

2018 ◽

Vol 20 (5) ◽

pp. 568-573

Author(s):

Ivan Sisa ◽

María Herrera-Fontana ◽

María Bovera ◽

María Palomeque ◽

Enrique Teran

Keyword(s):

Urban Population ◽

Salt Intake ◽

Sodium Intake ◽

Population Sample ◽

Reference Value ◽

Population Level ◽

Urban Setting ◽

Cross Sectional ◽

High Sodium ◽

Sodium Consumption

Objective High sodium consumption is associated with cardiovascular disease (CVD). CVD is the leading cause of mortality in Ecuador, which may be caused in part by unhealthy eating habits. Currently, there are no data on the consumption of sodium using 24-hr urine samples. The aims of the study were to provide preliminary data of sodium intake in an urban population sample consisting of adults between 25 and 64 years old, and to explore the feasibility to conduct a population-level sodium intake determination by using 24-hr urine samples.Methods A cross-sectional study was conducted in a sample of 129 adults living in an urban setting. 24-hr urinary samples were collected and the WHO STEPS instrument was used to collect the socio-demographic and clinical characteristics of participants. A reference value of 2.0 g/day was used to differentiate between normal and high sodium intake groups.Results Participants’ median age was 39 years, 91% of them identified themselves as belonging to the mestizo race, and 60% were female. The average sodium intake was 2 655(±1 185) mg/d (range: 1 725 to 3 404), which is equivalent to a salt intake of 6.8 g/d (range: 4.4 to 8.7). Sodium intake was significantly higher in males than in females: 3 175(±1 202) mg/d vs. 2 304(±1 042) mg/d, respectively, (p<.01).Conclusions Sodium consumption in two-thirds of the participants was higher than the WHO recommended level. These results should help to support the execution of a national sodium intake survey that, in turn, would provide information to guide and plan public health strategies seeking to decrease cardiovascular diseases occurrence rates in Ecuador.

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Considerations for Measurement of Sodium Intake

American Journal of Lifestyle Medicine ◽

10.1177/1559827620946737 ◽

2020 ◽

Vol 14 (6) ◽

pp. 585-588

Author(s):

Vanessa Almeida ◽

Todd Seto ◽

Jinan Banna

Keyword(s):

Cardiovascular Disease ◽

Risk Factor ◽

Salt Intake ◽

Sodium Intake ◽

Lifestyle Changes ◽

Individual Action ◽

Dietary Interventions ◽

Cvd Risk ◽

Salt Consumption ◽

Rehabilitation Programs

Current salt consumption is the major risk factor for hypertension and consequently cardiovascular disease (CVD). Accurate measurement of Na intake is an important component of developing dietary interventions to treat hypertension and lower CVD risk. Given that existing methods have a large subject burden, quick and practical ways to assess Na intake in individuals, particularly in hypertensive subjects, are needed. Such tools may be used for motivation to quantify salt intake and to set targets for lifestyle changes for prevention of CVD within a clinic setting. Patients at high risk of development of CVD may be identified and targeted for motivational interviewing. They may also be used as part of cardiac rehabilitation programs and will allow individuals to measure their own intake and to see the results of their individual action.

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